Rectal bleeding, or blood in stools, refers to any blood that is passed out of the anus.Some cases would just have blood stain on toilet paper when wiping. It can be quite distressing to see the entire toilet bowl covered with fresh blood for the more severe cases. Some bleeding occurs without being accompanied by stool, other times the blood is mixed with stool. Most of the time bleeding is not life threatening but occasionally it may be so severe that it can cause low blood pressure and giddiness.
The color of the blood may be indicative of where the bleeding occurs. Fresh blood tends to come from the area nearer to the anus. Bleed from deeper part of the colon would appear darker. Bleeding that arises from the stomach would cause stool that is completely black. It appears like tar and has a distinctive fishy smell.
Sometime the amount of blood in stool is too little such that it cannot be seen with a naked eye. Stool test may reveal the presence of blood in these cases. In Singapore, the kit to test for blood in stool are distributed freely for eligible Singaporean by organization such as Singapore Cancer Society.
Causes Of Blood In Stool
The most common cause of blood in stool is haemorrhoid or piles. It results from swelling of blood vessels near the anus. There may or may not be a lump at the anus. The blood tends to be bright red. The amount of bleeding varies. Other symptoms of piles includes itch, pain and mucus discharge.
If the bleeding is associated with severe pain in the anus, the most likely cause is anal fissure. It usually occurs after passing very hard stool and feels like “passing a knife” through the anus.
Cancer of the colon can also cause bleeding. Sometimes, blood in stool may be the only symptom of colon cancer. Other symptoms of colon cancer occurs in the later stages are: abdominal pain, change in bowel habit, weight loss and shortness of breath (from lack of blood)
Polyps of the colon are likely precursor to cancer itself. Most of the time it does not give rise to any symptoms but sometimes it can cause bleeding.
Blood in stool can also occurs with inflammation of the colon. This can occurs when someone gets a severe bacterial infection causing diarrhoea with blood and fever, often called dysentery. Another condition that occurs with diarrhoea with blood and fever is inflammatory bowel disease.
Assessment Of Blood In Stool
You should visit a clinic if you have blood in your stool. The doctor will determine your risk of having a more serious cause other than piles after talking to you and conducting a rectal examination. If he feels that your bleeding is not from a simple piles, he will refer you to see a gastroenterologist, a specialist that helps to manage gut symptoms. You should never ignore the blood in your stool.
The gastroenterologist would likely carry out colonoscopy to determine the exact cause of the bleeding.
If your stool have blood on stool testing, you will likely also need colonoscopy.
Cost Of Colonoscopy
A good proportion of the cost of the colonoscopy is covered with Medisave deduction in Singapore. It is also fully covered in most cases of private health insurance and company health insurance.
Treatment And Management
Treatment of blood in stool depends on the causes.
Bleeding from piles are often self-limiting. it will also often response to simple medication available from family doctors. Sitz bath can be helpful at times. Sometimes piles or haemorrhoid ligation can be done to treat it. The more sever cases may need surgery.
Bleeding from anal tear involve medication that is applied on the anus. Stool softening often would help.
Bleeding from the more serious causes would need proper treatment of the underlying cause.